Interview with Performance Coach & Massage Therapist Patrick Ward
A special thanks to performance coach and massage therapist Patrick Ward (OptimumSportsPerformance.com) who took the time to answer my questions about arm care for high school baseball players.
# 1: High school baseball players (particularly pitchers) endure a lot of “wear & tear” on their arm over the course of a season. Without the same access to trainers & therapists as college players and professionals, what are some therapeutic & recovery measures you would recommend during the season?
While it is true that high school athletes may not have the same access to therapy as professional athletes, there are several things that they can do to ensure proper recovery between training and competition.
First, we need to determine why the “wear and tear” is happening. Are the athletes playing to frequently? Are they overtraining? Have they been playing the same sport year round without breaks?
These are all important questions to ask when speaking with an athlete who is complaining of being overworked.
Next, and probably most importantly, as coaches we need to determine what we can TAKE OUT of the training program before adding something back in. To often people want to add in recovery strategies, but in reality, we should be trying to eliminate the stuff that is creating you to get “beat up” in the first place. This really goes back to the first questions I asked above. Does the athlete need a break? Can we eliminate some practices or competitions? Can we make practices shorter and more focused?Can we make training/lifting shorter and more focused? Are we trying to train/lift too much during a period of high competition/practice? You can do all the recovery stuff you want, but if you keep going out there, grinding it out, and overtraining, then the recovery strategies wont make a difference. So take things away first to allow for optimal recovery. Review your training program and make sure you aren’t trying to do too much stuff.
Finally, the best thing the high school athlete can do for recovery is develop some healthy strategies. Not only will these strategies help them with their recovery, but also it will set them up with healthy habits for the rest of their lives. These are very basic things like eating a balanced diet and getting adequate protein, fruits and vegetables, staying hydrated and drinking enough water (drinking water and staying hydrated is highly underrated as a recovery strategy), and getting the appropriate amount of sleep (high school students are notorious for staying up late and not sleeping enough). Additionally, being aware of the other stressors. High school athletes have a tremendous amount of stress placed on them – school stress, social stress, family stress, sports/athletic stress, training/lifting stress, financial stress, etc. Imagine a pot of water on the stove and each stressor causes the temperature of the stovetop to increase. At one point or another, many of these stressors will be firing at the same time (especially around midterm and finals time, when the athletes are taking lots of tests, staying up late studying or writing papers, and generally have a high level of anxiety). The training stress might be that last stressor to push the temperature up just enough to cause the water to boil over and spill out all over the stove. From a coaching standpoint, this comes down to understanding your athletes and getting a feel for where they are on any given training day. You have to call the shots and determine if today’s session is a good day to ramp things up and go for PR’s or pull things back, recover a little bit, and live to train hard another day.
Aside from that, if you can get some good soft tissue therapy every now and then it can be extremely helpful. I think of soft tissue therapy in two ways – corrective or restorative. Corrective soft tissue work would be trying to improve the tissue quality with a specific objective. For example, you may be working on a certain area with the objective of getting the athlete off the table to try and move/function better, or you may be using the soft tissue therapy during a time of injury, when you need to improve tissue quality and decrease ischemia, trigger points, or fascial adhesions. Corrective soft tissue work is another added stressor as it is highly specific and focused work, so keep that in mind when trying to implement this sort of therapy. Restorative on the other hand is just as the name implies. Generally this would be a less stressful massage, not really focused specifically on one area, and the goal is more just focused on getting you to relax.
# 2: Sore elbows are an “all-too-common” ailment for high school baseball players early on in the spring. In lieu of a progressive throwing program (which includes long toss) to condition the arm for the season, what therapeutic techniques would you use on an athlete complaining of a sore elbow?
I think the answer to this question really comes down to how good your assessment is prior to spring practice. Understanding fundamental movements and the dynamics of the sport are critical as this will drive your assessment and help you to understand what to look at. One of the issues with this is that most high school sports coaches know very little about assessing their athletes, so when spring practice roles around, there is no way of telling which kids need to be doing more remedial work before starting their training program, and which kids are able to begin a normal throwing program. This is where having the baseball coach refer out to a qualified strength coach or athletic trainer to perform the appropriate assessments would be beneficial.
So, therapeutically, the answer should be…WE DON’T WANT TO HAVE TO DO ANY THERAPY! We want to screen the kids out and make sure we address things before they become a problem and we need to refer them out to a medical professional for a therapeutic intervention.
The elbow takes a beating during a baseball throw. Between throwing a baseball and a tennis serve, the elbow joint moves through an arc between 75-100 degrees in about 20-35msec. When athletes complain of having a sore elbow, typically this is the area that we look at. However, the site and source of the problem may not be the same place. Kibler and Sciascia did a great job of looking at the entire kinetic chain and its implications to elbow dysfunctions. They state that when looking at an athlete with elbow symptoms it is important to look at factors that influence loading of the elbow, such as, the shoulder, trunk, hips, and legs. A common finding that they note is previous ankle sprain in the contralateral (opposite) foot, which is the plant foot (for a right handed pitcher, this would be the left foot). Additionally, they go on to say that painful and/or dysfunctional shoulder movement is present often times before the onset of elbow pain.
These are important points to note as a strength coach because our screening process will allow us to better understand the athletes we are working with and guide us in assessing these areas to determine if the athlete has any special needs that should be addresses prior to jumping into a full throwing program or if the athlete needs to be referred out first to a medical professional for further evaluation.
For my movement assessment I like to use the Functional Movement Screen, as I feel it gives me an adequate snapshot of the athletes’ abilities in 7-basic movements. Besides the movement screen, for a throwing athlete looking at their posture and thoracic spine function is important. While the elbow may be painful, this is often times a result of poor shoulder function which, if we trace that back even further we will see poor scapular control and further back from that decreased thoracic spine function. It has been well documented that scapular stability is necessary for optimal shoulder function as proper scapular mechanics allow the rotator cuff musculature to efficiently contribute to the movement of the shoulder by keeping the head of the humerus centered in the joint (Kibler). Beyond that, the muscles that stabilize the scapula all have attachments onto the spine. If the thoracic spine is not moving properly, you can train scapular stability all day, but those muscles will never be able to adequately contribute to proper movement in a more dynamic situation. So addressing thoracic spine mobility first would be helpful.
Besides the shoulder, scapula and thoracic spine, the assessment should look at hip mobility and core function. The Functional Movement Screen covers a lot of the bases, and adding a few specific tests that look more closely at specific joints of the throwing athlete will be beneficial in giving you a whole picture and helping to understand where to begin with that athletes training and throwing program. This will help alleviate some of the elbow pains that typically come with spring practice.
#3: Recently, I had a long toss session with one of my clients (for the first time in years) and the next morning my back and posterior shoulder were brutally sore, what specifically can an athlete do to speed up his recovery from such a “max-effort” workout?
Before anything else, I think we need to look at the first part of your statement. This was the first time in years that you performed a long toss session. Obviously, there is going to be some soreness from this sort of work. So, properly increasing the volume and intensity of your throwing program is important. Much like training, we can’t just show up to the gym and try and do a max effort workout if we haven’t trained in years. Well, we can…but the results will be similar to what you are currently experiencing.
Throwing programs should be progressive, just like training. You don’t want to go out there and throw everything you have got and then be shot for the next seven days. You need to have a specific program that allows for recovery between throwing sessions and varies between max effort throwing (like a game situation) and recovery throwing (like a light bullpen session).
The key to recovering between workouts is to understand the type of stresses you are placing on your body. Everyday should not be a max effort day. Alternating between days of higher intensity and lower intensity can be very helpful in the overall program design. Giving yourself some rest after a max effort throwing day is very important – there is a reason that major league pitchers get five days off in between starts! People tend to think of lower intensity days as useless because you aren’t working your hardest or setting PR’s. THAT’S OKAY! Not everyday needs to be a PR day. It is more important to be processes oriented and have a training program that leads you down the road to a specific goal. If we have a hard workout, typically the next day will be lower in intensity (and volume) and we will do more tempo runs, body weight circuits, or low intensity medicine ball work. This shouldn’t be so much work or such high intensity that it kills you. The goal is to just get out there and move around and allow the body to recover a little bit and stay “primed”, so that it is ready for the next high intensity session.
#4: You use A.R.T. in your practice – what is it and how can it help pitchers recover between “max-effort” throwing sessions?
Active Release Techniques (ART) is a type of soft tissue therapy that is centered on dealing with fascial restrictions/adhesions or nerve entrapment. This is one of the techniques we employ at our facility, but in reality, no one technique is more important or more “magical” than another. I’d rather go to a therapist that is skilled in dealing with soft tissue rather than someone who is ART-certified but has poor touch.
I have a few different soft tissue therapy tools in my toolbox and knowing when to use one technique over another is what will ultimately make the session more effective. As I stated in an earlier response, I think of soft tissue therapy in two ways – corrective or restorative. In between max effort throwing sessions (games), I’ll use different techniques depending on the needs of the athlete, with the main goal being to improve overall tissue quality and movement/function. Helping them decreased perceived levels of soreness is one benefit that many athletes enjoy from massage therapy and having more a relaxing/restorative massage may be helpful following a day of high intensity work, but to me the real goal is what we can do when they get off the table. If we limit the work to just table work and then the athlete leaves, we may be missing out on some excellent improvements in movement. So, I use the manual therapy as a way to improve tissue quality, decrease ischemia/trigger points/fascial adhesions, and improve range of motion. Then, we get the athlete up off the table and have them go through some exercise/movements to have them really own the new range of motion that we have developed on the table in a real world and more dynamic role.
#5: In your opinion, is bench pressing “bad” for pitchers? Are there any specific upper body exercises or protocols you’d recommend for pitchers?
This is a heavily debated topic amongst strength coaches, and the complaint about barbell bench pressing is that scapulo-humeral rhythm is not optimal.
For my overhead athletes, I don’t have them bench press with the barbell but sometimes they may do some bench pressing with dumbbells, as this allows for a freer movement. We do a lot of push up variations for the overhead athletes as this allows the scapula to move freely and helps them create stability with their own body, where as in a bench press stability is gained from the bench itself as well as you driving your feet into the ground.
Other than that, we do a lot of pulling/rowing movements as well.
Patrick Ward holds a Masters Degree in Exercise Science and is the founder of Optimum Sports Performance. He is a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association (NSCA), a Certified Personal Trainer (CPT) and Performance Enhancement Specialist (PES) through National Academy of Sports Medicine (NASM), and a USA Weightlifting-Certified Club Coach. In addition, Patrick holds a diploma in massage therapy and is currently licensed in the state of Arizona (LMT #12232). He specializes in clinical, therapeutic and sports massage, is certified In Neuromuscular Therapy, and has taken courses in Active Release Technique. Patrick’s professional experience working with a diverse clientele ranges from training for general health, to rehabilitation, to athletes who want to take their abilities to the next level.
